MORNBFI Vol. 1 - Planters Development Bank

APP. Q-47a08.12.31Ms. Ma. Ramona GDT SantiagoManaging DirectorTreasury DepartmentBangko Sentral ng PilipinasA. Mabini corner P. Ocampo Sts.Manila 1004(Trust Entity/Department’s Letterhead)Annex 1Date:______________________Dear Ms. Santiago:This refers to the placement/s amounting to (Peso Amount) placed in the BSP’s SDA facility at(SDA rate) % per annum for value (Value date) to mature on (Maturity date).This is to certify that the above placement/s is/are transacted on behalf of the following Tax-Exempt Institutions (TEI) or tax-exempt funds and interest income thereon are exempt from the twentypercent (20%) final withholding tax based on the corresponding BIR rulings:Tax Exempt Institutions Basis Amount(BIR Ruling No. and date)1.2.3.(rows may be increased depending on number of placements)TOTALThis is to further certify that above placements will be owned by the specified TEIs/tax-exemptfunds for as long as these placements are outstanding.In the event that the BSP is assessed for deficiency final withholding tax on the above placementsby the Bureau of Internal Revenue (BIR), (NBFI name) shall be liable for and pay such deficiency taxesand surcharges, and/or indemnify/reimburse the BSP for such deficiency taxes and surcharges that thelatter may eventually pay to the BIR as a result thereof. Further, (NBFI name) hereby authorizes the BSPto automatically debit its regular demand deposit account with the BSP for payment or reimbursement ofany such deficiency taxes and surcharges.Sincerely yours,HEAD OF TRUST DEPARTMENTSUBSCRIBED AND SWORN to before me this ____ day of____________________ 2007 at______________________, affiant exhibiting to me his Community Tax Certificate/Passport No.____________, issued at _________________, on _____________________.Doc. No.Page No.Book No.Series of_________;_________;_________;200___Notary PublicQ RegulationsAppendix Q-47a - Page 2Manual of Regulations for Non-Bank Financial Institutions